HARMONIZATION OF CLINICAL-PRACTICE GUIDELINES FOR THE PREVENTION AND TREATMENT OF OSTEOPOROSIS AND OSTEOPENIA IN EUROPE - A DIFFICULT CHALLENGE

Europe is a patchwork of various medical cultures and financial resour ces. Variations abound with respect to financing, accessibility to pub lic health systems, health expenditures, drug registration and reimbur sement, the prescription of drugs, and clinical applications, as well as the perception of osteoporosis itself. However, there are possibili ties for the harmonization of medical services among the various count ries within Europe. The European Agency for the Evaluation of Medicina l Products (EAEMP) is attending to the centralized or decentralized pr ocedures for the registration of drugs. The Group for the Respect of E thics and Excellence in Science (GREES) is investigating guidelines fo r drug registration as well as gathering and making available medical references. The European Foundation for Osteoporosis and Bone Diseases (EFFO) is increasing awareness of the prevalence of the disease and t he need for prevention and treatment. Finally, the International Feder ation of Societies on Skeletal Diseases (IFSSD) is coordinating epidem iologic, clinical, and social research. There is a need for increased awareness of osteoporosis throughout Europe. Health authorities are in need of cost/benefit reports leading to the registration and reimburs ement of agents. Primary care physicians need information about osteop orosis and need to become involved in the diagnosis and science of the disease. Awareness needs to be generated among specialists; they need to be educated in the latest techniques for diagnosis and treatment. Finally, the general population needs to become aware of osteoporosis and to be encouraged to participate in the prevention and treatment of this disease. Current screening and detection in Europe is being done by densitometry. However, other techniques on the horizon include ult rasound and biochemical markers. Primary prevention, i.e., maximizing peak bone mass, includes examining the genetics of osteoporosis to det ermine the high-risk population and promoting reasonable physical exer cise and dietary/life-style habits (e.g., increased calcium and avoida nce of tobacco). Secondary prevention includes the identification of h igh-risk groups through risk factors, biochemical markers, and densito metry and adherence to the World Health Organization definition of ost eopenia-osteoporosis (adapted to financial concerns by GREES guideline s). Other therapies include hormone replacement agents (although there are risks for cancer and concerns about durability), calcium and othe r inhibitors of bone resorption, physical activity, and vitamin D prop hylaxis in the elderly. Treatment of established or severe osteoporosi s includes drugs upon availability (inhibitors of bone resorption and stimulators of bone formation), surgery, and experimental approaches.